Effect of the Teaching Program Regarding Partograph on Midwives Knowledge at Delivery Room in KarbalaCityHspitals

: Background: Partograph was a first graphic assessment of progress of labour was designed by Friedman It is a cheap instrument designed to provide a constant graphic overview of labour and has been shown to enhance outcomes when used to manage and monitor labour. The purpose of the partograph, also called the partogram, is to help midwives record, interpret, analyze


INTRODUCTION:
According to world health organization(WHO) in 2004 each year out of the 210 million women becoming pregnant, 20 million will experience pregnancy-related illnesses and 5,00,000 died due to complications of pregnancy and childbirth.Most maternal and newborn deaths occur around the time of delivery (1) .Globally, there were an estimated of 287,000 maternal deaths in 2010.This means, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth.About 99% of maternal deaths occur in developing countries, while more than half of these deaths were preventable (2) .Half a million women lose their lives every year because of pregnancy related complications.Obstructed labour and ruptured uterus contributes up to 70% of maternal mortality.Early detection of abnormal progress and prevention of prolonged labour can significantly reduce it (3) .
The main causes of maternal deaths are hemorrhage, infection, pre-eclampsia, eclampsia, unsafe abortion, obstructed labour, anemia, hepatitis etc. Obstructed labour rate about 8%, Prolonged labour was commonly occur due to cephalopelvic disproportion which may result as complications such as obstructed labour; maternal dehydration, exhaustion, uterine rupture and vescicovaginal fistula (4) .The first graphic assessment of progress of labour was designed by Friedman in 1954 and further improved by Philpott and Castle in1972 (5) .
Abundanteffort has been done to enhance the partograph as ainstrument which graphically represents key events during labour and acclimatizes it for use worldwide.The partograph is an cheapinstrument designed to supply a continuous pictorial overview of labour and has been shown to enhance outcomes when used to observer and manage labour.It is a single sheet of paper which contains information about the fetus' heart rate, uterine contraction, any drugs used and other important elements that could assistanceevade extensive descriptive notes.With its use, there is no need to record labour events repeatedly.It helps predict deviation from normal progress of labour, and supports timely and proven intervention.It also helps to facilitate responsibility to the person conducting labour (6) .techniques to monitor labor thus play an important role in saving women's lives (7) .

Objetives:
1-Assess the knowledge of midwives regarding partograph (pre-test) for both group (study and control group).2-Assess the knowledge of midwives regarding partograph (post-test)for study group.3-Find the association between knowledge of both groupsafter the program.

METHODOLOGY:
Study design:Quasi experimental design for two groups(study and control) was found to be effective for the present study.Sample: Sample were consist of 50 midwives working in delivery room in Karbala hospitals.The sampling technique use in this study was non probability convenience method of sampling ; Setting:In this study the target population was consisted of all midwives working in delivery room in Maternity Teaching Hospital and Al-Hindyia General Hospital of a Holy Karbala city.This Study is carried out in Holy karbala city from December, 3 th , 2014 to May, 26 th , 2015.Instrument:Thequestionnairewas consisted of (25) items of multiple choice questions under 3 categories such as meaning and definition, purpose and principles, monitoring labor and charting of partograph.Each question has 4 answer (1 correct answer and 3 false answer), the score "1" was given for correct answer while the score "0"was given for wrong answer.The result of scores were ranged as follows: 1-Poor knowledge ≥ 12% .2-Fair knowledge 13-19% .3-Good knowledge <20% .Validity:The content validity of the tool was established inconsultation with guide of experts from the field of obstetrics and gynecology department of nursing & medicine and other field specialties.Suggestion of the experts were considered for modification and changes which were made accordingly.Data collection:The data collection were carried out during the period fromFebruary 1 st to February28 th ,2015.Data analysis:The collected data was analysis by using descriptive statistics (mean, mean percentage, standard deviation) and T-test to find out the association between the demographic variables and the scores of knowledge.1 demonstrates demographic characteristic of the study sample.In study group the higher percentage (40%) of midwives their age ≥ 30 years old, while the lowest percentage (24%) for the age group(25-29) years.themajority (80%)of study group were graduated from secondary midwifery school.In sequence (16%) were graduated from secondary nursing school and the (4%) graduated from technical-medical institute.The higher percentage (76%) of midwives how have general experiences for(less)<5 years.While the lowest percentage (4%) for (5-9) years.The majority of midwives percentage were having experiences in delivery room of (80%) for(less) <5 years and the lowest percentage (4%) for (5-9)years.In control group the higher percentage (48%) of them were for age 20-24 years old.While the lowest percentage(12%) of them (25-29) years old.Most of these midwives were married (56%) while only (8%)were widowed.The majority (80%)of them were graduated from secondary midwifery school.The lowest percentage (8%) were graduated from school of nursing, the higher percentage (48%) of midwives general experiences for (less)< 5 years.While the lowest percentage (12%) for (10-14) years.Majority of midwives percentage were having experiences in the delivery room of (64%) for(less) <5 years and the lowest percentage (16%) for (5-9)years.This table shows that there was a significant difference between pre &posttest in study group concerning p-value of most items for midwives knowledge regarding use of partograph in the delivery room.

Table ( 2)Distribution of significant midwives knowledge (pre-test & post-test) for both group regarding the use partograph in the delivery room .
*Significant difference in proportions using Pearson Chi-square test at 0.05 level.

Table ( 3
) shows that (88%) of midwives have poor knowledge regarding partograph in study group and (92%) in control group, 12%have fair knowledge in study group and 20%in control group, 80% of midwives have good knowledge in study group after implementation of teaching program regarding partograph